For this article I describe interviews with two women who are in mid-career and also tell about some of my own experiences in psychiatry. In the seventies and eighties, there were more women in medical school and residencies, but they were still outnumbered by their male colleagues. We had female role models who had already made it through training. Still, many of us were first generation career women.

Meenakshi Vimalananda, M.D., grew up in India and attended Christian Medical College in Vellore. It had originally been a women’s medical school, but when she attended there were an equal number of men and women. She married her husband, Dr. Samson Vimalananda, before graduation. He was Christian and she was of the Jain faith. Part of their motivation for moving to America was its greater tolerance for inter-faith marriages

Dr. Vimalananda did her residency and fellowship at Spring Grove State Hospital and the University of Maryland. She finished training in 1980. Shortly after moving to America, she became pregnant. She felt isolated and missed India. She worked up to the day of delivery. She had a series of bad experiences with nannies. Eventually, she put her children in daycare. All along, Dr. Vimalananda considered her role as a “mom” to be more important than her role as a physician. Her husband, also a psychiatrist, was supportive and took an active role in raising the children. When a child woke at night either of them might get up. She is proud of her children's accomplishments. Her son earned his MPH, worked on violence prevention issues, and is now applying to medical school. Her daughter is an undergraduate at Tufts University.

Dr. Vimalananda is currently the head of the Child and Adolescent Acute Care Service line at Sheppard Pratt Hospital, where she has been on staff for almost 20 years. She has seen tremendous changes in the practice of psychiatry while she has worked there. When she first started, long hospitalizations were common. She has always preferred to keep inpatient hospitalizations brief; however, she feels that insurance companies and managed care organizations have pushed the short-term model too far.

Lisa Dixon, M.D. is currently Director of residency training at the University of Maryland. She grew up on Long Island, New York, in a family that had the same expectations for the sons and daughters. When she was in college, her older brother, a medical student, was diagnosed with schizophrenia. Seeing him struggle reinforced her decision to go into medicine and increased her interest in psychiatry.

Dr. Dixon attended Cornell University Medical College. This was a difficult time in her life. Her father died of a heart attack while she was in her first year and her brother’s illness progressed. Her family found it difficult to get good care for him. These experiences were quite stressful, but her medical school was supportive. She felt that these painful experiences made her more understanding of others’ turmoil. They also sensitized her to the personal and family difficulties her trainees might face.

Dr. Dixon didn’t experience sexism in her training. She notes that she might have been too concerned with her own difficult life experiences to notice any. When she was a third year medical student, she was assigned to an intern who was to become her husband and they were engaged nine months later. Dr. Dixon completed her residency training at The Payne Whitney Clinic in New York City. Geography became an issue when her husband had an opportunity to do a fellowship in Washington D.C. She interviewed at NIMH, but felt that at the time, it might be difficult for a woman to fully fit in. She went to work at the Maryland Psychiatric Research Center (MPRC). The move to Maryland was difficult because she did not know anyone in the area. She was eager to have children. “That can be tough because having children does not always go according to anyone’s plans or schedules,” Dr. Dixon stated. She transferred from MPRC to a program for the homeless mentally ill. Dr. Tony Lehman was a supportive mentor to her in that program.

Dr. Dixon did not find it difficult to go back to work when her two children were infants. However, now that they are six and nine, she feels that they need her more. They had two difficult experiences with nannies, but the third one was very good. They have had her for over six years. However, that nanny has given notice that she will be leaving.

Dr. Dixon has always worked full-time. She describes herself as a driven person. She thinks that she would drive her children crazy if she were home full-time! She has found that working in an institution with a team has allowed her to keep good boundaries and to get home at a reasonable time. She has tried to be home evenings and weekends. She sees one potential barrier for women trying to advance in academic medicine. Academic advancement is enhanced by national and international recognition. However, she limits her traveling because it takes her away from her family for too long. She enjoys being residency training director, but sometimes finds it emotionally draining.

Carol Watkins, M.D. I would now like to tell you about my own experience. When I started college, I planned a career in medical research and did not want children. One medical school interviewer asked me what I would do if I became pregnant in medical school. I refused to answer unless he guaranteed me that he routinely asked male applicants what they would do if they got their girlfriends pregnant. Although I did not complain (except to everyone in my dorm!), the school somehow heard about it and re-interviewed me.

I met my husband during our first year of medical school. We were at a party and I heard him talking about Freud. I came across the room and challenged him to show me data to back up his assertions. We were both interested in psychiatry and began to study together. We got married in our fourth year of medical school. We applied to psychiatry programs as a “matched set.” We decided on Maryland because it had a good psychotherapy program. At the time there was a fair bit of training money, so we had ample supervision, a good didactic program, and the flexibility to pursue our particular interests. I had not planned to become a child psychiatrist, but enjoyed my child rotation so much that I decided to do a child fellowship.

I started psychoanalytic training, but eventually realized that I was not cut out to be an analyst. I went to work at Sheppard Pratt, first on a long-term inpatient unit and then at the Forbush School. We then decided to have children. It soon became evident that my pregnancies would involve some extra medical risk, and that I might end up on bed rest. I took my Child Psychiatry Boards during my third trimester. My obstetrician gave me the names of some good hospitals in Minneapolis in case I went into early labor.

I worked 2/3 time and had a nanny for about nine months. Unexpectedly, our nanny had some problems. I felt badly that I had not detected them, and decided that if two psychiatrists could not do a better job of interviewing nannies, then I should stay home and raise the children myself. I tearfully left my job at Forbush and I got another position working one day per week, while my husband worked four days per week. Over time, the arrangement evolved into more of a 50-50 arrangement. Now that all three children are in school, we have begun to work longer hours. I had been active on committees during residency, but put that on hold while my children were young. Now I have more time for writing and committee work. Sometimes I regret that I did not pursue a full-time academic career. I have seen others do an excellent job of combining academics and motherhood, but I did not feel capable of doing both while my children were young. However, my children have more than repaid me for changing directions. My own parenting mistakes have made me more humble with my patients and their families.

Women who trained in the seventies and eighties were still in the minority, but experienced a different world than did their predecessors. Still, there could be role strain when they juggled medicine and parenting. Pregnancy and childbirth could not be scheduled as readily as work schedules and residency rotations. All of the women profiled in this article had supportive husbands who took active parenting roles. Despite this, all three women had some difficulties arranging quality childcare. Parenting demands changed with the ages of the children, not always decreasing as the children matured.